Dental Caries and Tooth Loss in Adults in the United States,

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1 NCHS Data Brief No. 97 May 05 Dental Caries and Tooth Loss in Adults in the United States, 0 0 Bruce A. Dye, D.D.S., M.P.H.; Gina Thornton-Evans, D.D.S, M.P.H.; Xianfen Li, M.S.; and Timothy J. Iafolla, D.M.D., M.P.H. Key findings Data from the National Health and Nutrition Examination Survey, 0 0 Among adults aged 0 64, 9% had dental caries and 7% had untreated tooth decay. Untreated tooth decay was higher for (36%) and non- black (4%) adults compared with non- white (%) and non- Asian (7%) adults aged Adults aged 0 39 were twice as likely to have all their teeth (67%) compared with those aged (34%). About one in five adults aged 65 and over had untreated tooth decay. Among adults aged 65 and over, complete tooth loss was lower for older (5%) and non- white (7%) adults compared with older non- black adults (9%). Dental caries and tooth loss are important oral health indicators for adults and are key measures for monitoring progress toward health promotion goals set by Healthy People 00 (,). Although tooth decay and complete tooth loss have been declining in the United States since the 960s, disparities have remained between some groups (3,4). As adults age, oral health-related quality of life is negatively affected by tooth loss and decay (5). This report describes U.S. adult dental caries and tooth loss by age and race and origin for 0 0. Keywords: tooth decay edentulism disparities NHANES What percentage of adults had dental caries in permanent teeth? Approximately 9% of U.S. adults aged 0 64 had dental caries in permanent teeth in 0 0 (Figure ). Dental caries among adults aged was Figure. Prevalence of dental caries in permanent teeth among adults aged 0 64, by age and race and origin: United States, 0 0 Dental caries experience Non- white Non- black Non- Asian Untreated dental caries Non- white Non- black Non- Asian , , Percent Includes untreated and treated (restored) dental caries. Significantly different from ages 35 49, p < Significantly different from ages 50 64, p < Significantly different from non- black adults, p < Significantly different from adults, p < Significantly different from non- Asian adults, p < NOTE: Access data table for Figure at: SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 0 0., ,5, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics

2 NCHS Data Brief No. 97 May 05 higher (94% 97%) compared with adults aged 0 34 (8%). The prevalence of caries among adults aged 0 64 was lower for (85%), non- black (86%), and non- Asian (85%) adults compared with non- white adults (94%). During 0 0, about 7% of adults aged 0 64 had untreated tooth decay in permanent teeth. Little difference was seen in the prevalence of untreated dental caries between the age groups examined. The prevalence of untreated dental caries was nearly twice as high for non- black adults (4%) compared with non- white (%) and Asian (7%) adults. Untreated tooth decay was lower among non- white and Asian adults compared with adults (36%). What percentage of older adults had dental caries in permanent teeth? In 0 0, nearly all U.S. adults aged 65 and over (96%) with any permanent teeth had dental caries (Figure ). The prevalence of dental caries was similar among those aged and those aged 75 and over. Caries prevalence was lower for non- black (9%) and (86%) adults compared with non- white adults (98%). Figure. Prevalence of dental caries in permanent teeth among adults aged 65 and over, by age and race and origin: United States, 0 0 Dental caries experience and over Non- white Non- black Non- Asian , Untreated dental caries and over Non- white Non- black Non- Asian,3, Percent Includes untreated and treated (restored) dental caries. Significantly different from non- black adults, p < Significantly different from adults, p < Significantly different from non- Asian adults, p < NOTE: Access data table for Figure at: SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 0 0.

3 NCHS Data Brief No. 97 May 05 Approximately 9% of adults aged 65 and over had untreated caries in 0 0. No difference was seen in untreated dental caries prevalence between those aged and those aged 75 and over. Untreated tooth decay was significantly higher for non- black adults (4%) compared with (7%), non- white (6%), and non- Asian (7%) adults. Older non- Asian and adults were more likely to have untreated dental caries compared with older non- white adults. What percentage of adults had no loss of permanent teeth? Forty-eight percent of adults aged 0 64 had a full set of permanent teeth (excluding third molars) (Figure 3). Twice as many adults aged 0 39 (67%) had retained all of their permanent teeth compared with adults aged (34%). Tooth retention was lower among non- black adults (38%) compared with non- white (5%), non- Asian (49%), and (45%) adults. adults also were less likely to have retained all of their teeth compared with non- white adults. No difference was noted between men and women in the percentage of adults experiencing no tooth loss due to dental disease. Figure 3. Prevalence of permanent tooth retention among adults aged 0 64, by age, sex, and race and origin: United States, , Percent Men Women Non- white Non- black Non- Asian Significantly different from ages 40 64, p < Significantly different from non- black adults, p < Significantly different from adults, p < NOTE: Access data table for Figure 3 at: SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey,

4 NCHS Data Brief No. 97 May 05 How prevalent was complete tooth loss (edentulism) among older adults? Nearly 9% of adults aged 65 and over were edentulous in 0 0 (Figure 4). Edentulism was twice as prevalent among adults aged 75 and over (6%) compared with adults aged (3%). More non- black adults aged 65 and over were edentulous (9%) compared with non- white (7%) and (5%) adults. Although the prevalence of complete tooth loss was higher among older non- Asian adults (4%) compared with older and non- white adults, this difference was not statistically significant. The prevalence of edentulism was similar between men (8%) and women (9%). Figure 4. Prevalence of complete tooth loss (edentulism) among adults aged 65 and over, by age, sex, and race and origin: United States, Percent and over Men Women Non- white Non- black Non- Asian Significantly different from ages 75 and over, p < Significantly different from non- black adults, p < NOTE: Access data table for Figure 4 at: SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey,

5 NCHS Data Brief No. 97 May 05 Summary Disparities by age and race and origin for dental caries and tooth loss existed among U.S. adults in 0 0. For adults aged 0 64, dental caries was lower for, non- black, and non- Asian adults compared with non- white adults, whereas untreated tooth decay was more prevalent among and non- black adults compared with non- white and Asian adults. Nine of 0 adults aged 0 64 had dental caries, and caries experience was more prevalent among adults aged than among younger adults. In contrast, a little more than one-quarter of adults aged 0 64 (7%) had untreated tooth decay, and the prevalence of untreated caries did not vary as adults aged. About one-half of adults aged 0 64 living in the United States had not lost a tooth in 0 0. Tooth retention was twice as prevalent among adults aged 0 39 compared with those aged Non- black adults were more likely to have lost one or more teeth compared with, non- white, and non- Asian adults. Oral health disparities by age and race and origin also existed for older adults in 0 0. Although nearly all adults over age 65 had experienced dental caries, caries prevalence was higher among older non- white adults compared with older non- black and adults. However, in this age group, non- black adults were more likely to have untreated tooth decay compared with, non- white, and non- Asian adults. Overall, 9% of adults aged 65 and over were edentulous in 0 0. Edentulism was twice as prevalent among adults aged 75 and over compared with those aged Although little difference was seen in the prevalence of edentulism between men and women, differences by race and origin for complete tooth loss did exist in 0 0. Older non- black adults were more likely to be edentulous compared with older non- white or adults, and nearly one in four older non- Asian adults were edentulous in 0 0. Definitions Untreated dental caries: Dental cavities (tooth decay) that have not received appropriate treatment. Dental caries: Having a tooth appropriately treated for tooth decay or having untreated decay present. Tooth retention: Having all natural permanent teeth present, excluding third molars. Edentulism: Having all natural permanent teeth missing, including third molars. Data source and methods Data from the National Health and Nutrition Examination Survey (NHANES) were used to produce this report. NHANES is a cross-sectional survey designed to monitor the health and nutritional status of the civilian noninstitutionalized U.S. population. Survey participants are selected through a complex, multistage process that includes oversampling in order to obtain reliable estimates of health and nutritional measures for population subgroups. In 0 0, 5

6 NCHS Data Brief No. 97 May 05 oversampling included, non- black, and non- Asian persons. The survey consists of interviews conducted in participants homes and standardized physical examinations in mobile examination centers (MECs). Additional information on NHANES is available from: From 0 through 0, the NHANES oral health assessment was conducted in MECs by trained dentists. The assessment included a tooth count to identify the presence or absence of permanent or primary teeth, including retained dental root tips and dental implants. Each tooth surface was assessed for dental caries and restorations. Dental examinations were conducted using a dental light for illumination, a dental mirror, and an explorer. Overall, preliminary data reliability analyses conducted for 0 0 indicate that examiner performance was similar to prior survey periods ( ) using the same dental caries examination methods. Population estimates and standard errors were calculated in SAS-callable SUDAAN software release.0 (RTI International, Research Triangle Park, N.C.). Examination sample weights to account for differing probabilities of selection, nonresponse, and noncoverage were used for analysis. The standard errors of the percentages were estimated using Taylor series linearization, to take into account the complex sampling design. Differences between groups were evaluated using a t statistic at the p < 0.05 significance level. All results presented have a relative standard error less than 30%. All differences discussed are statistically significant unless otherwise indicated. Calculated estimates were not age-adjusted, and no adjustments were made for multiple comparisons. About the authors Bruce A. Dye is with the National Institutes of Health s (NIH) National Institute of Dental and Craniofacial Research. Gina Thornton-Evans is with CDC s National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health. Xianfen Li is with CDC s National Center for Health Statistics, Office of Analysis and Epidemiology. Timothy J. Iafolla is with NIH s National Institute of Dental and Craniofacial Research. 6

7 NCHS Data Brief No. 97 May 05 References. HHS. Healthy People 00. Available from: HHS. Oral health in America: A report of the surgeon general Available from: 3. Dye BA, Tan S, Smith V, et al. Trends in oral health status United States, and National Center for Health Statistics. Vital Health Stat (48) Dye BA, Li X, Beltrán-Aguilar ED. Selected oral health indicators in the United States, NCHS data brief, no 96. Hyattsville, MD: National Center for Health Statistics Thomson WM. Epidemiology of oral health conditions in older people. Gerodontology 3 Suppl :

8 U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics 33 Toledo Road, Room 549 Hyattsville, MD FIRST CLASS MAIL POSTAGE & FEES PAID CDC/NCHS PERMIT NO. G-84 OFFICIAL BUSINESS PENALTY FOR PRIVATE USE, $300 For more NCHS Data Briefs, visit: NCHS Data Brief No. 97 May 05 Suggested citation Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and tooth loss in adults in the United States, 0 0. NCHS data brief, no 97. Hyattsville, MD: National Center for Health Statistics. 05. Copyright information All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. National Center for Health Statistics Charles J. Rothwell, M.S., M.B.A., Director Nathaniel Schenker, Ph.D., Deputy Director Jennifer H. Madans, Ph.D., Associate Director for Science Division of Health and Nutrition Examination Surveys Kathryn S. Porter, M.D., M.S., Director For updates on NCHS publication releases, subscribe online at: For questions or general information about NCHS: Tel: 800 CDC INFO ( ) TTY: Internet: Online request form: ISSN Print ed. ISSN Online ed. DHHS Publication No CS55709

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